Dependent personality disorder describes a deep need to rely on others and an intense fear of separation. People with dependent personality disorder are unable to make even simple decisions without help, and are deeply afraid of being abandoned or rejected. Women are more susceptible to dependent personality disorder than men, but not by a significant ratio.

Causes of Dependent Personality Disorder

The exact cause of dependent personality disorder, as with so many mental conditions, remains a mystery. A severe childhood illness may predispose an individual to dependent personality disorder, as can the presence of childhood separation anxiety disorder.

Other research suggests that parenting styles play a role in dependent personality disorder. Excessively overprotective parents may prevent a child from developing independence, and condition them to expect others to care for them. Strict, authoritarian parenting that permits a child little freedom or responsibility may also be a dependent personality disorder risk factor.

Genetic origins for dependent personality disorder have been suggested, and evidence of a genetic link has been found in a few cases. No single factor, genetic or otherwise, has yet been identified that could account for all dependent personality disorder cases.

Symptoms and Diagnosis

Diagnosis of dependent personality disorder is made through comparing the patient's symptoms to the symptoms of dependent personality disorder as laid out in the DSM-IV. To qualify as dependent personality disorder under the DSM-IV criteria, the patient must display at least five of the following conditions:

• has difficulty making everyday decisions without an excessive amount of advice and reassurance from others
• needs others to assume responsibility for most major areas of his or her life
• has difficulty expressing disagreement with others because of fear of loss of support or approval.
• has difficulty initiating projects or doing things on his or her own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy)
• goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant
• feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself
• urgently seeks another relationship as a source of care and support when a close relationship ends
• is unrealistically preoccupied with fears of being left to take care of himself or herself.

From the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, 1994.

Dependent Personality Disorder and Relationships

People with dependent personality disorder are so terrified of separation that they will go to any lengths to maintain a relationship, including suffering physical or sexual abuse. Therapists treating dependent personality disorder must be cautious if discussing abusive relationships. Patients may end therapy if they believe the therapist threatens the relationship, no matter how abusive and unhealthy the relationship is.

When relationships do end, the dependent personality is devastated, but quickly forms a new attachment to avoid being alone. Despite a desperate need to be in a relationship, the dependent personality is not necessarily emotionally attached to his or her partner. A relationship fulfils the dependent personality's need to abdicate personal responsibility and be taken care of. Deep emotional bonds need not be present. One "caregiver" is as good as another.

Treating Dependent Personality Disorder

People with dependent personality disorder are unlikely to seek treatment for their condition. They are typically unaware that their concerns with abandonment and need to be cared for are abnormal.

No specific treatment exists for dependent personality disorder. Psychotherapy can help people become more independent and take responsibility for their lives, but to be effective treatment must be long-term. Medication may help if dependent personality disorder is due to underlying medical problems.

Resources

American Psychiatric Association. Diagnostic criteria for 301.6: Dependent personality disorder. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. American Psychiatric Association, Washington, DC, 1994.

Ekleberry, S. (2000). Dual diagnosis and the dependent personality disorder.

Long, P. (nd). Dependent personality disorder.

National Library of Medicine. (updated 2003). Dependent personality disorder. MedlinePlus Medical Encyclopedia.